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Diabetes and anxiety fact sheet

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Anxiety is often a healthy response to a perceived threat. For most people, anxious feelings go away after the threat has passed. For some people, the fear becomes so intense and long lasting that it starts to affect daily life, including work, school, relationships and diabetes management. If you feel this way, you may have an anxiety disorder, but you are not alone. There are many things you can do to reduce your anxiety.

 “There are definite issues that come up, especially around anxiety and low blood sugar. One of the symptoms is anxiety—that fight or flight response—so understanding whether you’re experiencing anxiety for psychological reasons or for physical glucose reasons is quite a difficult thing.”

Andrew, 59, person with diabetes

What is anxiety?

Anxiety is an excessive amount of fear in anticipation of something bad happening. Usually, this is a healthy response to a real threat. For example, certain situations, such as public speaking or having a ‘hypo’ (hypoglycaemia, or low blood glucose), can trigger anxious feelings.

Anxiety becomes a serious problem (a mental health condition, known as an ‘anxiety disorder’) when these feelings last for a long time (i.e., at least two weeks) and affect daily life adversely.

Symptoms of anxiety include:

  • feeling nervous or on edge
  • being unable to stop worrying or control worrying thoughts
  • worrying too much about things
  • having trouble relaxing
  • being so restless that it’s hard to sit still
  • becoming easily annoyed or irritable
  • feeling afraid that something awful might happen.

Anxiety also has physical symptoms, including:

  • muscle tension
  • a racing heart
  • tightness in the chest
  • an upset stomach.

If you have had any of these symptoms for at least two weeks, talk to your general practitioner (GP). They can make an assessment, offer treatment and/or refer you to a mental health professional.

It is important that you seek advice from a health professional.

What has anxiety got to do with diabetes?

Anxiety is the most common mental health issue that Australians experience. Among people with diabetes, some have anxiety before a diagnosis of diabetes, while for others, specific fears associated with managing diabetes (e.g., hypos, fear of developing complications) may trigger anxiety.

The link between anxiety and diabetes is not yet fully understood, and research is ongoing.

What is clear is that anxiety can affect the way people manage their diabetes and, in turn, their physical health. Some examples include:

  • checking blood glucose levels continuously due to intense fears of hypos or developing complications
  • avoiding injecting in public, or not injecting at all, due to worry about what others might think.

“A few years ago I was really anxious, but it wasn’t just the diabetes. Diabetes was just one factor, but it was a focal point.”

Louise, 27, person with diabetes

Do you feel this way because of anxiety or diabetes?

Some of the symptoms of anxiety are very similar to those of a hypo), such as trembling, sweating, or a fast heart rate. This can make it difficult to know whether you are anxious, having a hypo, or both. If you are not sure, always check your blood glucose, as this will help you to become increasingly aware of your own reliable symptoms of a hypo. You will learn to understand whether you are experiencing feels of anxiety or, in fact, having a hypo.

Even if anxiety is not related to your diabetes, it can have negative effects on your health, life, and relationships.

What you can do

It is important that you seek help from your GP or another qualified health professional. They can help you to identify if you have an anxiety disorder and offer treatment or make a referral to a mental health professional if needed.

If you don’t have an anxiety disorder, your health professional can help you to understand what else might be causing the symptoms.

Whether or not you are experiencing anxiety, it’s important to look after your emotional well-being.

Some of the following strategies may work for you—others may not, and that’s okay. They may give you ideas about other things you could try.

Reach out

Anxiety can make you feel like you are alone and may stop you from going out. If you feel this way, talk to someone you trust. People who care about you will want to support you.

  • Make a point of talking to at least one person every day.
  • If you don’t feel like you have anyone to share your feelings with, call a helpline, talk to your GP, or join a support group or online community. You don’t need to go through this alone.

Move your body

Physical activity has powerful effects on the brain and can improve the way you think and feel about yourself. Try to be active every day.

  • Yoga relaxes and calms both the body and the mind. There are many types of yoga and you don’t have to be a yogi master to feel the benefits.
  • Start small. For example, start with one short walk every second day, then gradually increase the time you spend walking and how often you walk. Or take the stairs, park your car further away, break up work for a stretch.
  • Try to get out and enjoy nature while you move, as this helps to reduce stress.

Get enough sleep

Being tired makes it difficult to feel calm and relaxed. Try to have a sleep routine by going to bed and waking at the same times each day.

The following tips might help:

  • Keep a sleep diary to help you understand some of your patterns.
  • Reduce your caffeine intake: limit your coffee, tea, and soft drinks, and don’t drink them after 4pm.
  • Be active during the day but avoid don’t do strenuous physical activity right just before bedtime.
  • Remember, your bed is for sleeping, so avoid watching TV, checking emails, or using your phone in bed.
  • Make sure the room is quiet and dark.

Don’t try to mask it

It is common for people with anxiety problems to misuse alcohol, prescription medications or illegal drugs. People adopt these behaviours as a way of coping, but they are just a short term fix and don’t resolve the real problem. These ways of coping don’t help in the long term, as people become dependent on them. This increases their anxiety and/or can cause other health or relationship problems.

Don’t try to fight it

When we feel anxious, our initial reaction is often to tell ourselves to ‘stop being ridiculous’ or ‘get over it’. Fighting against anxiety doesn’t work and may actually make it worse. You may have thoughts such as, ‘What is happening to me?’ or ‘I’m having a heart attack … or a hypo!’ These thoughts increase your anxiety.

It’s better to work with the symptoms of anxiety and let them be, rather than working against them. This doesn’t mean you should resign yourself to these symptoms or like them. Acknowledge that they are there and that it is your body’s way of telling you something is wrong. You could try:

  • Observing what it is you are feeling (e.g., fear, fast heart rate).
  • Acknowledging whatever it is that you are feeling by saying aloud or silently to yourself, ‘I’m feeling …’
  • Thanking your body for being such a great protector, and for doing such a thorough job at helping to keep you safe.
  • Telling yourself, ‘This will pass’.

Breathe

Relaxation is a powerful way of reducing anxiety. Try a breathing relaxation exercise (see box Breathing relaxation exercise). Find a quiet room for this activity, and sit in an upright and comfortable position. The more you practice, the better you will become at naturally calming yourself during times of high anxiety. Once you’ve tried it a few times, it may surprise you with how helpful it is for improving your well-being. If this kind of thing isn’t for you, that’s okay, just skip it.

Breathing relaxation exercise

  1. Focus on your breathing. Take a deep breath in through your nose. Hold… then exhale through your mouth, as if you are blowing out a candle. Blow out all the air.
  2. Focus on slowing down your breathing into a calm rhythm. Exhale fully, releasing all the air.
  3. As you continue to breathe slowly and deeply, repeat the following calming messages to yourself silently:
    • I’m feeling anxious right now but I’m okay.
    • I’m safe, even though I feel frightened.
    • This feeling will pass and no harm will come to me.
  4. If you are shaking or trembling, try to physically shake out the tension. Imagine that you are shaking water off your hands to dry them. Now stop and notice how much more relaxed your hands feel.
  5. Now relax the muscles in your body. Let all the muscles go limp. Then tense the muscles in your body—hold on really tight for a minute or so, without causing pain. Then release and let the muscles go limp again. Notice how relaxed your muscles feel.

Talk with a professional

The strategies above may give you some ideas about how to prevent or reduce anxiety, but they can’t replace professional help. It’s always a good idea to talk about your concerns with your GP or another qualified health professional.

Who can help?

Your diabetes health care team

Your diabetes health care team is there to help you with all aspects of your diabetes, including how you feel about it. Share your feelings with them if you feel comfortable to so do—they will give you non-judgemental support and advice. You may want to talk with your:

  • GP
  • endocrinologist
  • diabetes educator
  • nurse practitioner
  • dietitian
  • counsellor or psychologist.

Bring this fact sheet to your appointment to help get the conversation started. You will probably feel relieved after sharing your feelings, and it will help your health professional to understand how you are feeling.

Together, you can make plans to manage your anxiety.

A psychologist or psychiatrist

You might also like to talk with a psychologist or psychiatrist. These professionals are best placed to make a diagnosis and provide treatment for anxiety. Treatment may involve the following:

  • One-on-one counselling (e.g., cognitive behavioural therapy)
  • Medication (e.g., anti-anxiety drugs)
  • A combination of psychological therapy and medication.

Ask your diabetes health professional if they know a psychologist or psychiatrist in your area who is familiar with diabetes, or try the following options:

You will need a referral from your GP to see a psychiatrist but not to see a psychologist.

Your GP can tell you if you are eligible for a Mental Health Treatment Plan to reduce the costs of seeing a psychologist or psychiatrist.

More information and support

beyondblue

beyondblue.org.au or ph 1300 224 636

Beyondblue provides information and support to people with depression or anxiety, or anyone going through a tough time. Support services are available via telephone, email or live chat, including online forums where you can connect with others.

Lifeline

lifeline.org.au or ph 13 11 14

Lifeline offers 24-hour confidential telephone and online crisis support. People contact Lifeline for a range of reasons, including feelings of depression, stress, anxiety and suicidal thoughts or attempts.

Peer support

ndss.com.au
(search for ‘Publications & Resources’)

To find out about what peer support is and how you can access it in your area, refer to the National Diabetes Services Scheme (NDSS) leaflet, Peer support for diabetes.

Diabetes Australia and the NDSS

diabetesaustralia.com.au
ndss.com.au
NDSS Helpline 1300 136 588

Through the NDSS, you can access a free national NDSS Helpline to obtain information about diabetes and learn about education programs, peer support groups and other events.

The NDSS and you

A wide range of services and support is available through the NDSS to help you manage your diabetes. This includes information on diabetes management through the NDSS Helpline and website. The products, services and education programs available can help you stay on top of your diabetes.

This fact sheet is intended as a guide only. It should not replace individual medical advice and if you have any concerns about your health or further questions, you should contact your health professional.

Version 2 December 2018. First published June 2016.